Compliance Update

State Farm loses FDUPTA claims against providers

The jury spoke November 8, 2023 in the pending litigation “State Farm Auto. Ins. Co. v. Michael Thomas Larocca, DC, et al,” case number 8:21-cv-2536-SCB-AEP. The 16 Defendants, which included chiropractors, medical doctors, and nurse practitioners were held not guilty of committing fraud, civil conspiracy, unjust enrichment, and violating the Florida Deceptive and Unfair Trade Practices Act...

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Florida Man Convicted in $67M ‘Doctor Chase’ Genetic Testing Healthcare Fraud Scheme

Another defendant who was part of a multimillion-dollar healthcare fraud scheme tied to unnecessary genetic testing has been convicted by a federal jury. Jose Goyos of West Palm Beach was indicted in February 2022 along with nine others in the Southern District of Florida for their alleged roles in a $67 million healthcare fraud, wire fraud, kickback, and money laundering scheme involving the...

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Understanding Florida APRN Medication Dispensing Requirements

APRNs are highly educated and trained healthcare professionals. In Florida, Advanced Practice Registered Nurses (APRNs) have an expanded scope of practice which allows APRNs whose protocols allow, to prescribe and dispense medications to patients under certain conditions and in accordance with state regulations. Medication dispensing by APRNs can improve patient access to essential medications....

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2024 ICD-10-CM Changes Are Imminent

Every year, CMS issues clarifications, additions and deletions to diagnosis codes that become effective on October 1, 2023. For 2024, CMS announced 395 new diagnosis codes, 25 deletions and 13 revisions. Although there are many changes in wording, synonyms and instructional notations, below are the most salient code changes but please note that this is not an exhaustive list. Do check CMS...

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Lincare to Pay $29M to Settle Medicare Overbilling Healthcare Fraud Case

Florida-based Lincare Holdings has agreed to pay $29 million to settle allegations it overbilled Medicare and Medicare Advantage plans for oxygen equipment provided to patients with respiratory-related illnesses. The settlement, which is the largest ever healthcare fraud settlement in the Eastern District of Washington settles claims that Lincare violated the False Claims Act. Lincare Agrees to...

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‘Just following orders’ isn’t a defense to fraud

A case from North Carolina highlights what we see too often: healthcare entrepreneurs and providers committing fraud, paying monetary penalties and even facing incarceration. But rarely do we see the penalties travel down the ladder to a company’s employees. A pharmacy owner was sentenced to 24 months this month for conspiracy to commit fraud. Apparently, the pharmacy owner ran a scheme for 11...

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